The treatment of mandibular condyle fractures: a meta-analysis

The treatment for mandibular condyle fractures remains controversial. Conservative management (CM) and open reduction/internal fixation (ORIF) are both used, but the evidence to support superiority of one method over the other has not been assessed.

We performed a meta-analysis of studies comparing CM versus ORIF in patients with condyle fractures. The primary outcome was post-treatment function; we looked at the status of the post-treatment occlusion, mouth opening, protrusion, facial height, pain and the presence of postoperative ankylosis. Furthermore, in studies evaluating ORIF, adverse effects such as facial nerve weakness and scarring, were also recorded.

Twenty (20) studies enrolling 1596 patients were eligible. These included four randomized controlled trials (RCTs) and 16 non-randomized case series. Only 1186 of these patients were analyzed by the studies; the reasons for exclusion were rarely clarified. All four RCTs were prospective but the majority (69%) of the remaining studies were retrospective. The inclusion criteria were described in all four RCTs; however, this was not the case in half of the remaining studies (44%). Only four (20%) studies were blinded. Across all included studies, we recorded great variation between treatment protocols, follow-up periods, and outcomes measured. This precluded any quantitative synthesis. In nine studies (45%) the superiority of ORIF over CM reached statistical significance. The incidence of facial nerve weakness following ORIF averaged 6% and it was temporary for the majority of the patients. The identified RCTs were small (160 patients) and suffered from a number of methodological shortcomings. All of them reached statistically significant conclusions favoring ORIF over CM.

The current meta-analysis suggests that ORIF for condylar fractures may be as good or better than CM. The morbidity associated with the operation is low. However, the available evidence is of poor quality and not strong enough to change clinical practice.